Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

  • Work order number

Untitled Page

(T)ools, (S)afety Equipment and (M)aterials

  • Grease and grease gun

  • Tools for cleaning debris

  • Flashlight

Safety Guidelines

  • Schedule outage with operating personnel

  • Block traffic and set up alternate security measures

  • Follow site safety rules for lockout and tagout

  • Report equipment damage or deficiencies

  • Review and follow manufacturer's O&M instructions

  • Use extreme caution around moving gates and barriers. Moving gates can kill you or someone else

Maintenance Procedures

  • Grease all fittings and the clevis pin

  • Clean all debris from under barrier

  • Look for signs of damage to barriers, pumps, or control units

  • Inspect the condition of the finish

Maintenance Hours

  • Estimated time spent on work order?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.